This invention relates to cardiovascular surgical instruments and comprises an improved vessel holder for use as an aid in the execution of selected cardiovascular surgical procedures, one specific application being in coronary artery bypass surgery and peripheral vascular surgery. The invention is adaptable for holding not only a vein graft, but also an internal mammary artery, bioprosthetic grafts, or synthetic grafts, such as Dacron.RTM. or Gortex.RTM..
It is common surgical practice to use bypass grafts to help reestablish coronary artery circulation. In most patients one or usually more segments of the saphenous vein taken from the patient's legs, or other vessel graft, will be implanted between the aorta, near its base, and just distal to the blockage of the branch of the stenosed coronary artery. In some patients, the internal mammary artery, or another vessel graft, is also utilized for bypassing the most important coronary artery that is stenosed.
The saphenous vein is dissected free from the leg, its side branches tied off, and the vein removed. The vein graft is then washed free of blood, and cut into portions of suitable length. Each portion is then passed to the surgeon who trims the ends of the graft before anastomosing the graft to the aorta and the coronary artery. Most surgeons choose to complete all the proximal anastomoses (to the aorta) before commencing the distal anastomoses to the coronary arteries. In contrast, others choose to complete the distal anastomoses first. Regardless of the order, when undertaking the distal anastomosis to the coronary artery, it is important that the vessel graft be held steadily and adjacent to the coronary artery, with a minimum of vascular trauma and a minimum of visual and surgical obstruction by instruments in the narrow operative field.
The vessel holder, which is the subject of this invention, is intended for use as an aid to the surgeon in this circumstance by allowing the distal end of the saphenous vein or other vessel graft to be held in an open position adjacent to the coronary artery during the anastomotic procedure, without obstructing the surgeon's vision. The use of this vessel holder to hold the graft steady eliminates the use of multiple instruments, such as forceps or retractors. Forceps are commonly used to hold the angled open end of a vein graft in close proximity to the coronary artery while the cardiovascular sutures are being placed. The forceps are obstructive, difficult to hold steady, can easily slip, or cause damage to the delicate vein graft. These difficulties are minimized with the present invention.
Vessel holders are known in the art. For example such a device was described in U.S. Pat. No. 4,651,733 entitled "Blood Vessel Holding Device and Surgical Method Using Same." The disadvantage of this device is that it has to be inserted into the lumen of the vein graft, potentially causing intimal damage, and it's function ceases after only one half the anastomotic sutures have been taken. The improved vessel holder does not have these limitations.
Scanlan International company sells a Scanlan Solem vein holder, catalogue number 1001-760. This device is a pen like hollow plastic tube with a single stainless steel clip that holds the vein graft to the holder. The drawback of this device is that it is somewhat obstructive and fails securely to hold the vein.
The device that is the subject of this invention does not have these disadvantages.
It is an objective of this invention to provide a vessel holder.
It is a further objective of this invention temporarily to hold open the end of the vessel graft during anastomosis thereby to improve surgical exposure.
It is a further objective to provide an instrument that will hold open the vessel graft without traumatizing the blood contact portion of the saphenous vein or other vessel graft.
It is a further objective of this invention temporarily to hold open the end of the saphenous vein or other vessel graft in a controlled manner during anastomosis thereby to improve surgical exposure.
It is a further objective of this invention to accommodate saphenous vein or other vessel graft grafts of different sizes.
It is a further objective of this invention to provide a vessel holder with a malleable handle.
It is a further objective of this invention to provide a vessel holder with an elastic member to hold the body of the vessel graft or the graft cannula to prevent the said graft body from falling into the operative field.
It is a further objective of this invention to provide an alternative embodiment of the vessel holder such that the surgeon may choose the most suitable arrangement, depending upon the anatomy of the patient and upon whether the left anterior descending, the diagonal and the circumflex branches of the left coronary artery, or the right coronary artery is to be bypassed. The simplicity and design of the vessel holder are such that it is inexpensive and therefore may be disposable, thus eliminating the necessity of cleaning and sterilizing between uses.
Other objectives and advantages of this invention will be more apparent from the detailed description of the device that follows.